PBS/RPBS

Community pharmacy operates in a highly regulated environment to provide the highest quality of care in delivering cost-efficient, safely dispensed pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS).

Community pharmacies are central to the effective operation of the PBS. Australia’s 5000 pharmacies are well-distributed throughout metropolitan, suburban and rural regions providing convenient access to the community. Patients, in even the most remote locations, can be assured of receiving the medications they need within 24 hours (at most) of ordering thanks to the efficiency of the drug distribution network which includes manufacturers, wholesalers and pharmacists.

DVA Issues

While sponsors of RPBS-listed products are obliged to honour the listed RPBS price as part of the contractual arrangements with DVA, price changes may occur without notification or prior to acceptance and/or implementation by DVA.

Members can find out more about claiming procedures and other DVA Issues.

Location Rules

The objectives of the Location Rules, as set out in the Fourth Community Pharmacy Agreement, are to ensure:

all Australians have access to PBS medicines;

a commercially viable and sustainable network of community pharmacies dispensing PBS medicines;

improved efficiency through increased competition between pharmacies;

improved flexibility to respond to the community need for pharmacy services;

increased local access to community pharmacies for persons in rural and remote regions of Australia; and

continued development of an effective, efficient and well-distributed community pharmacy network in Australia.

Unapproved Pharmacies

The Australian Government Department of Health is committed to preventing the occurrence of fraud against health related programs.

Should you have concerns about a potential breach of the Conditions of Approval for approved pharmacists, or any other compliance matter, you can report your concerns to the Health Provider Compliance Tip-off Line by calling 1800 314 808 or submitting the details to the Department online by completing the Tip-off form.

Please note that the Department is not able to provide complainants with updates due to legislated privacy and secrecy provisions.

Community Service Obligation

Since 2005, the Australian Government has provided funding for a Community Services Obligation (CSO) Funding Pool. The CSO Funding Pool ensures that all Australians have ongoing access to the full range of PBS medicines through community pharmacies. It provides financial support to pharmaceutical wholesalers, supplying the full range of PBS medicines regardless of pharmacy location and the relative cost of supply.

The CSO Funding Pool helps ensure that low volume PBS medicines are delivered to community pharmacies anywhere in Australia and that all PBS medicines are delivered to rural and remote community pharmacies.

The two main objectives of the CSO are to ensure that:

all community pharmacies are able to obtain timely supply of the full range of PBS medicines, regardless of the size or location of the pharmacy, the breadth of the PBS product range, the cost of the medicines or the cost of their distribution and supply; and

all Australians have timely access to the PBS medicines they require, regardless of the cost of the medicine, or where they live.

Guild members have access to industry experts who can advise on the CSO and assist with complaints. Members can find out more on the Community Service Obligation page.

If you wish to talk to the Guild about the CSO, please email your enquiry to guild.nat@guild.org.au or call the National Secretariat on (02) 6270 1888.

S100 PBS Programmes

While the majority of PBS medicines are distributed through community and hospital pharmacies under Section 85 (S85) of the National Health Act (Cth), there are a number of PBS medicines for which alternative arrangements are in place under Section 100 (S100) of the National Health Act (Cth). These are known as Section 100 Programs and include:

Highly Specialised Drugs Program

Efficient Funding of Chemotherapy

Botulinum Toxin Program

Growth Hormone Program

IVF Program

Opiate Dependence Treatment Program

Community Access

Since July 2015, there have been changes to a number of S100 programs to provide consumers with greater access to these medicines and greater choice in where they have their S100 medicines dispensed. The aim of these changes have been to better align existing S100 programs with current clinical practice and models of care, through the way these medicines are prescribed, dispensed and accessed.

Ordering, Remuneration and Claiming

Different ordering and PBS remuneration arrangements apply to S100 Program medicines, and some PBS prescriptions cannot be dispensed and claimed by a community pharmacy.